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SAN ANTONIO — A former Air Force nurse intentionally gave three elderly Texas patients lethal doses of medication, killing them with his self-described “aggressive” care for end-of-life patients, prosecutors said Tuesday at the start of a court-martial.

Capt. Michael Fontana has pleaded not guilty to three counts of murder and a charge of conduct unbecoming an officer. He faces up to life in prison if convicted.

The three patients who died in intensive care last summer at Wilford Hall Medical Center in San Antonio were nearing the end of their lives, but family members wanted them comfortable, not hastened to death, said Capt. Ja Rai Williams, an Air Force prosecutor.

“All three people had something in common: excess doses of medication given by the accused resulting in a quicker death than anticipated,” Williams told the military judge, Col. William Burd, who will decide the case at Lackland Air Force Base.

The prosecution has offered no motive but said Fontana, an Iraq war veteran, openly talked about his “aggressive” care for terminally ill patients. During an Article 32 hearing — the military equivalent to a civilian grand jury — Fontana’s co-workers and medical experts indicated it was unlikely anyone with medical training would not have known he was administering lethal doses of painkillers.

Fontana’s attorneys argued Tuesday that the patients were gravely ill and their life-expectancy was impossible to predict. They also blamed vague doctors’ orders, poor hospital protocol and sloppy record-keeping in the intensive care unit for the deaths.

“People are there for a reason. They’re there because they’re critically ill. They’re there because they’re dying,” said Capt. Brent Dishman, one of Fontana’s attorneys. “These patients were expected to die, and they died as anticipated.”

Dishman said Fontana admitted giving patients morphine and other drugs and charting their use and agreed to talk to investigators.

“There was no intent to deceive,” he said.

Fontana, a former emergency medical technician in Austin, joined the Air Force in 2006 and served a tour in Iraq in 2007. He worked as an intensive care nurse at Wilford Hall, the Air Force’s largest hospital, last year. The hospital primarily serves military personnel and retirees but provides some emergency civilian care in southwest San Antonio.